Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
Kaiser Permanente Medical Center, Vallejo, California.
Clin Gastroenterol Hepatol. 2018 Oct;16(10):1593-1597.e1. doi: 10.1016/j.cgh.2018.04.014. Epub 2018 Apr 13.
BACKGROUND & AIMS: The fecal immunochemical test (FIT) is widely used in colorectal cancer (CRC) screening. The OC-Light FIT is 1 of 2 FITs recommended for CRC screening by the Preventive Services Task Force guidelines. However, little is known about its ability to detect CRC in large average-risk populations.
We performed a retrospective cohort study of patients (50-75 years old) in the San Francisco Health Network who were screened for CRC by OC-Light FIT from August 2010 through June 2015. Patients with a positive result were referred for colonoscopy. We used electronic health records to identify participants with positive FIT results, and collected results from subsequent colonoscopies and pathology analyses. The FIT positive rate was calculated by dividing the number of positive FIT results by the total number of FIT tests completed. The primary outcome was the positive rate from OC-Light FIT and yield of neoplasms at colonoscopy. Secondary outcomes were findings from first vs subsequent rounds of testing, and how these varied by sex and race.
We collected result from 35,318 FITs, performed on 20,886 patients; 2930 patients (8.3%) had a positive result, and 1558 patients completed the follow-up colonoscopy. A positive result from the FIT identified patients with CRC with a positive predictive value of 3.0%, and patients with advanced adenoma with a positive predictive value of 20.8%. The FIT positive rate was higher during the first round of testing (9.4%) compared to subsequent rounds (7.4%) (P < .01). The yield of CRC in patients with a positive result from the first round of the FIT was 3.7%, and decreased to 1.8% for subsequent rounds (P = .02).
In a retrospective analysis of patients in a diverse safety-net population who underwent OC-Light FIT for CRC screening, we found that approximately 3% of patients with a positive result from a FIT to have CRC and approximately 21% to have advanced adenoma.
粪便免疫化学检测（FIT）广泛应用于结直肠癌（CRC）筛查。OC-Light FIT 是预防服务工作组指南推荐用于 CRC 筛查的两种 FIT 之一。然而，对于其在大型普通风险人群中检测 CRC 的能力，我们知之甚少。
我们对旧金山健康网络中接受 OC-Light FIT 筛查的 50-75 岁患者进行了回顾性队列研究，筛查时间为 2010 年 8 月至 2015 年 6 月。阳性结果的患者被转诊行结肠镜检查。我们使用电子健康记录来识别阳性 FIT 结果的参与者，并收集随后的结肠镜检查和病理分析结果。阳性 FIT 率通过阳性 FIT 结果数量除以完成的 FIT 测试总数来计算。主要结局是 OC-Light FIT 的阳性率和结肠镜检查中肿瘤的检出率。次要结局是第一轮和后续轮次检测的结果，以及这些结果如何因性别和种族而异。
我们收集了 35318 次 FIT 检测结果，共对 20886 名患者进行了检测；2930 名患者（8.3%）的结果为阳性，1558 名患者完成了随访结肠镜检查。FIT 的阳性结果确定了 CRC 患者，其阳性预测值为 3.0%，高级别腺瘤患者的阳性预测值为 20.8%。第一轮检测的 FIT 阳性率（9.4%）高于后续轮次（7.4%）（P<.01）。第一轮 FIT 阳性结果患者的 CRC 检出率为 3.7%，后续轮次的检出率为 1.8%（P=.02）。
在一项对接受 OC-Light FIT 进行 CRC 筛查的多样性医疗保障人群患者的回顾性分析中，我们发现，约 3%的 FIT 阳性结果患者患有 CRC，约 21%的患者患有高级别腺瘤。
